Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 CANDIDATE / OFFICEHOLDER SPECIAL PRE-ELECTION REPORT 2 ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ LAST ○ ○ ○ ○ ○ ADDRESS / PO BOX; ○ 4 CANDIDATE / OFFICEHOLDER ADDRESS Date Received MI ○ FIRST NICKNAME C/OH-T OFFICE USE ONLY ○ MS/MRS/MR 3 CANDIDATE / OFFICEHOLDER NAME Total pages filed: ○ ACCOUNT # FORM ○ 1 (TDD 1-800-735-2989) SUFFIX APT / SUITE #; CITY; STATE; ZIP CODE Receipt # Date Hand-delivered Amount Date Processed 5 OFFICE SOUGHT Date Imaged POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES) 6 7 Date 9 Amount of Contributor name contribution ($) ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ State; ○ ○ ○ ○ ○ City; ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Contributor address; In-kind contribution description (if applicable) ○ 8 10 Zip Code (If travel outside of Texas, complete Schedule T) Contributor name Amount of contribution ($) ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ State; ○ ○ ○ ○ ○ City; ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Contributor address; In-kind contribution description (if applicable) ○ Date Zip Code (If travel outside of Texas, complete Schedule T) Contributor name Amount of contribution ($) ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ State; ○ ○ ○ ○ ○ City; ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Contributor address; In-kind contribution description (if applicable) ○ Date Zip Code (If travel outside of Texas, complete Schedule T) PLEDGED CONTRIBUTIONS Pledgor name Amount of contribution ($) ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ State; ○ ○ ○ ○ City; ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ Pledgor address; In-kind contribution description (if applicable) ○ Date Zip Code (If travel outside of Texas, complete Schedule T) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) Special pre-election reports cover the period beginning the ninth day before an election and ending at 12 noon on the day before the election. A special pre-election report must be filed with the Ethics Commission electronically, unless otherwise exempted from electronic filing. A special pre-election report must be received by the commission no later than the first business day after the date the contribution is accepted. A special pre-election report that is exempt from the electronic filing requirement is not required to be on a form prescribed by the commission; it may be on regular stationery. Contributions disclosed on a special pre-election report must be disclosed again on the next required report. Candidates for statewide office; district office filled by voters of more than one county; judicial district office filled by voters of only one county; State Board of Education; state senator; or state representative are subject to the requirement to file special pre-election reports. Special pre-election reports are required if a candidate accepts a contribution or contributions from a person that total more than $1,000 during the reporting period for special pre-election reports. The candidate is required to report the amounts of the contributions, the full name and address of the contributor, and the dates of the contribution or contributions. Reporting Travel Outside of Texas: The law requires detailed information regarding in-kind contributions and political expenditures for travel outside of Texas. This information should be reported on Schedule T and attached to this form. Schedule T can be found on the Ethics Commission's website at www.ethics.state.tx.us/whatsnew/ travel_outside_Texas.html. www.ethics.state.tx.us Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com